(1) When prescribing controlled substances, a CRNP or CNM shall use a prescription form that includes all of the following:
- (a) The name, medical practice site address, and telephone number of the collaborating physician.
- (b) The name of the CRNP or CNM;
- (c) The medical practice site address and telephone number of the CRNP or CNM if different from that of the collaborating physician;
- (d) CRNP or CNM's registered nurse license number assigned by the Board of Nursing.
- (e) The words "Product Selection Permitted" printed on one side of the prescription form directly beneath a signature line;
- (f) The words "Dispense as written" printed on one side of the prescription form directly beneath a signature line.
- (g) The date that the prescription is issued to the patient.
- (h) The patient's full name and address.
- (i) The CRNP or CNM's QACSC registration number.
Author: Alabama Board of Medical Examiners
Statutory Authority: Code of Ala. 1975, §§20-2-60, et seq.; Act 2009-489.
History: New Rule: Publication December 30, 2022; effective
February 13, 2023.